Vol 98, No 1 (2017)

Aim. To conduct comparative analysis of height, weight and body mass index in children with stages 1 to 3 of chronic kidney disease (CKD) caused by recurrent urinary tract infection due to congenital anomalies of kidney and urinary tract.

Methods. The study was performed on 210 children: 110 patients examined in 2001-2002 (group 1) and 100 children examined in 2011-2012 (group 2). Stage 1 of CKD was observed in 94 (85.4%) children in group 1 and in 93 (93%) in group 2, stage 2 - in 16 (14.6%) and 7 (7%) patients, respectively. From both groups patients matched by sex, age, diagnosis and social status were selected: 20 patients with stage 1, 19 children with stage 2; in addition, 6 children with stage 3 were examined.

Results. Nowadays children with CKD stage 1 are taller compared to patients of the beginning of the XXI century (Z-score: -0.14±1.43 and 0.20±0.98 respectively, p=0.01). Significant differences in weight were found in children with stage 1 in 2011-2012 compared to the patients in 2001-2002 (0.18±0.46 and 0.78±1.19 for groups 1 and 2, respectively, р=0.026). A tendency towards decrease of average height in children with stage 3 is observed compared to patients with stage 1, i.e. due to the progression of the disease.

Conclusion. The data obtained reflect modern tendencies towards increase of children height and weight. No significant differences were found in physical development parameters of children with stages of chronic kidney disease 1 and 2 examined at the same time period but a tendency towards children’s height decrease from stages 1 to 3 of CKD of non-glomerular etiology was revealed.

Aim. To study the efficacy of longitudinal resection of the stomach in treatment of patients with obesity according to the results of two-year follow-up after the surgery.

Methods. During the period between 2012 and 2015 24 patients with obesity were operated on. In all of them longitudinal resection of the stomach was performed. The age of the patients was 21 to 63 years, mean body weight was 118.8±18.67 kg, mean body mass index (BMI) was 42.3±5.8 kg/m2. Before and after the surgery evaluation of excess weight, presence and characteristics of anemia (red blood cell count, concentration of hemoglobin, serum iron and vitamin B12) and quality of life according to Hamilton scale was performed.

Results. Weight loss during the first 2 years after the longitudinal resection of the stomach was 68% and it was less pronounced in patients with increased BMI. In patients with BMI <35 kg/m2 at the admission body weight was close to normal by the end of the first year after the surgery. In 4 patients with iron deficiency anemia after 2 years of follow-up hemoglobin concentration was 15.7% below its average preoperative level. 5 (20.8%) patients developed postoperative pernicious anemia. The average concentration of vitamin B12 in observed patients was 421.4±87.9 pmol/L before the surgery and 316.8±64.3 pmol/L after 2 years (p <0.001). Patients’ quality of life was noted to be improved after the performed surgery.

Conclusion. Longitudinal resection of the stomach is a very effective method of obesity treatment; it allows to achieve significant loss of excess body weight and to improve patients’ quality of life.

Aim. Assessment of impact of probiotic lactobacilli complex on treatment efficiency and normalization of immune status in women with human papillomavirus infection (PVI).

Methods. Total of 65 patients of reproductive age with cervical pathology and PVI were examined. «Provag» was included into the standard therapy as the source of probiotic lactobacilli complex. Immunological studies were conducted before and after the treatment. The phenotypic profile of peripheral blood lymphocytes was determined by means of flow cytometry. The concentration of immunoglobulin A, G and M in serum was determined by ELISA.

Results. Decreased amounts of T- and NK-cells were observed in PVI patients on day 1. Regardless of treatment method, by day 30 the number of T-lymphocytes in the blood of women with PVI increases. Percentage of NK-cells remained below the normal values on day 30 in the group of patients who received traditional scheme of PVI treatment. Patients with PVI taking additionally probiotic lactobacilli complex showed an increase of NK-cells by the end of the treatment. On day 1 decrease of relative and absolute numbers of T-helper cells was detected. Regardless of the method of treatment by day 30 the number of T-helper cells increases to the reference level. IgM and IgG levels in peripheral blood of women with PVI were increased even on day 1. By the end of the observation period their concentration in patients with conventional treatment scheme remained increased. Patients receiving the standard therapy supplemented with «Provag» demonstrated the decrease of these classes of immunoglobulins to the reference level.

Conclusion. As a result of treatment normalization of NK-cells and T-helpers numbers was observed whereas the IgG and IgM levels remained increased.

Aim. To analyze sensitivity of magnetic resonance imaging (MRI) in the diagnosis of breast cancer when used after mammography and breast ultrasound.

Methods. The study included 70 patients with nonpalpable breast lesions who had changes of breast tissue found at previous studies (mammography and breast ultrasound). MRI was performed with the use of Siemens Magnetom Avanto with magnetic field 1.5 Tl.

Results. Most frequently nonpalpable lesions were diagnosed in 45 to 60-year old patients (60%), a little rarer - in 39 to 45-year old patients (22.9%), in patients at the age of 61 to 69 - in 10.0% (7 patients). 7.1% patients were over 70. All first detected nonpalpable lesions of breast were biopsied for morphological verification. With the combined use of mammography, sonography, MRI and stereotactic biopsy the diagnosis was made in 100% patients. MRI with contract enhancement showed no relation between sensitivity, specificity and reliability and density of breast tissues.

Conclusions. MRI is considered a highly sensitive method of diagnosis and identification of changes found at mammography and breast ultrasound.

Aim. To evaluate some health aspects of children born with different types of intrauterine growth restriction during the early neonatal period.

Methods. Clinical and anamnestic, physical, laboratory, electrophysiological, ultrasound and statistical methods were used. Children’s past medical history, development during early neonatal period, physical development, functioning of autonomic nervous system and cardiovascular system were assessed.

Results. It was revealed that development of different types of intrauterine growth restriction is related to father and mother’s age at the time of pregnancy, women’s body mass before pregnancy, and time of pregnancy complication development (abortion risk, pre-eclampsia, arterial hypertension, Rh-immunization, edema). Fetuses with asymmetric type of intrauterine growth retardation had survived hypoxia more often (by 4.87 times). Children with symmetrical type of intrauterine growth retardation were more often born by C-section (by 2.66 times), with smaller anthropometric measurements, with more frequent and severe hypotrophy, moderate and severe cerebral ischemia and mild intracranial hemorrhage, cryptorchidism, kidney diseases, atrial septal defects, muscular ventricular septal defects, open arterial duct, and depleted reserves. Children with asymmetric type of intrauterine growth retardation more often had hypoglycemia, jaundice, polycythemia, restricted adaptation reserves, myocardial metabolic disorders, anterior mitral valve leaflet prolapse, posthypoxic changes similar to hypertrophic cardiopathy.

Conclusion. Revealed features of past medical history, development during early neonatal period of life, physical development, functioning of autonomic nervous system and cardiovascular system in different types of children’s intrauterine growth restriction can promote formulation of criteria for early diagnosis of adaptive and reserve disorders and identification of dispensary groups.

Aim. Improving the efficiency of treatment of patients with chronic liver failure by optimizing the application of extracorporeal detoxification methods.

Methods. The study included 292 patients with chronic liver failure (188 males and 104 females). The main causes of chronic liver failure were nutritional factor (alcohol abuse), viral liver diseases, and the combination of alcoholic and viral factors. All patients regardless of the disease etiology were divided into groups. Patients in group 1 received standard conservative therapy, aimed at relieving the symptoms of chronic liver failure. Patients in group 2 were additionally administered plasma exchange, in group 3 - PE and high-volume venovenous hemofiltration, and in group 4 - sessions of molecular adsorbent recirculating system (MARS).

Results. Mortality of patients with chronic liver failure on conservative treatment accounted for 84.0% and was 1.5-2.1 times higher than in other groups (53% in plasma exchange group, 52% when using plasma exchange and high-volume venovenous hemofiltration and 40.6% in MARS group), these differences being statistically significant when compared with group 1 (χ2 from of 18.3 to 23.4, p <0.05). Indicators, reflecting the time of 50% mortality of patients with chronic liver failure of different etiology, suggest that in chronic liver failure of alcoholic origin plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are the most effective, and in chronic liver failure of viral and mixed etiology the best results are obtained when using MARS.

Conclusion. The effectiveness of treatment of patients with chronic liver failure depends on the etiology of the disease: in alcoholic chronic liver failure plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are most rational, and in chronic liver failure of viral and mixed etiology MARS sessions are rational.

Aim. To improve immediate and remote results of reconstructive restorative procedures in patients with complicated colorectal cancer.

Methods. The study is based on clinical experience of treatment of 107 patients who had reconstructive restorative procedures performed in specialized oncology institution after previous Hartmann’s procedure performed in urgent surgical department for complicated colorectal cancer. Reconstructive restorative procedures were performed at different time after the primary operation. To assess functional state of anal sphincter all patients were adminestered sphincteromentry during the preoperative period. Morphological analysis of all tissues removed during the surgery was performed. To evaluate morphological changes of distal end of the stump at different time a histological analysis was performed.

Results. According to the results of sphincterometry dynamic reduction of tonic contraction and maximum pressure of anal sphincter is observed. The more the period between Hartmann’s operation and reconstructive restorative surgery, the less pronounced muscle tone of anal sphincter. Histological studies of intestinal wall during the first 3 months after Hartmann’s surgery revealed intact quantity and size of intestinal crypts, non-significant inflammatory infiltration of mucous and submucous layers, during the period of 4 to 6 months - initial signs of diversion colitis, during the period of 7 to 12 months - atrophic changes in mucous membrane (reduction of crypts quantity, their shortening, decreased thickness of mucus), after 1 year - signs of atrophy of its submucous layer.

Conclusion. Reconstructive surgery in patients with previous Hartmann’s surgery for complicated colorectal cancer should be performed in specialized departments with all modern methods of surgical, radiation and medical treatment of colon cancer available; based on functional and morphological studies the optimal time frame for reconstructive surgery is 1 to 3 months after the initial surgery.

Aim. Development of a model of hindlimb ischemia in rats to assess the effectiveness of gene and cell therapy.

Methods. In the first stage of this approach the external iliac artery was ligated immediately after bifurcation of the common iliac artery. Then the femoral artery was ligated before its branching into the descending genicular, popliteal and saphenous arteries with following dissection of arteries between ligatures. The second stage of this approach was performed seven days after the completion of the first stage: branches of popliteal artery to gastrocnemius muscle and formed collaterals were ligated and dissected. Hindlimb blood flow was assessed by laser Doppler flowmetry. Animals were euthanazied 14, 17, 21, 28, 35, 42 days after the first stage. The paraffin sections of gastrocnemius muscles were stained with Mallory trichrome and with antibodies to CD34.

Results. Histopathological analysis showed a continuous hindlimb ischemia of operated limb without any native skeletal muscle structure restoration and with significant interstitial fibrosis (11.89±5.53% vs 2.55±2.13% in intact limb by day 42, p <0.05). Polymorphic muscle fibers in operated limb with significantly smaller diameter and reduced capillary density (0.82±0.03 vs 1.91±0.06 in intact limb by day 42, p <0.05) were revealed. Laser Doppler flowmetry revealed reduction of blood flow in the operated limb (0.67±0.22 of intact limb blood flow by day 42).

Conclusion. Our developed two-stage model of hindlimb ischemia in rats leads to histologic changes characteristic for the same pathology in human.

Aim. To analyze the situation with scientific personnel and its training in the field of medical sciences in Russian Federation for 1995-2014 years.

Methods. Statistical and analytical methods were used. This study presents the analysis of data on personnel capacity and training of postgraduate students and doctoral students in the field of medical sciences in Russia during the period from 1995 to 2014 with the use of informational and statistical resources.

Results. In Russian Federation during the period of 1995-2014 we revealed decreasing number of researchers with PhD (by 3.25%), increasing number of doctors of medical sciences (by 44.8%) and significantly decreased number of researchers without scientific degrees (by 29.6%). The ratio of people with scientific degree in the field of medical sciences is higher than in other fields of sciences (69.2 vs. 29.3%). The process of aging of scientific personnel is continually observed. The average age of researchers increased from 45 to 47 years, PhD researchers - from 49.0 to 51.2 years, doctors of sciences - from 58.0 to 63.3 years and it is higher than the average age of employed in the economy of Russia (40.4 years). 26.0% of researchers are over 60 years. The biggest outflow from sciences is observed among efficient and promising specialists at the age of 40 to 49. In the field of medical sciences the most efficient training of highly skilled personnel can be noted. Almost one in three postgraduates (31.3%) and doctoral students (27.0%) presents the results of their thesis for defending that is higher than in other fields of science (18.35 vs. 17.0%, respectively).

Conclusion. Decreasing number of researchers was revealed; the process of aging of scientific personnel is continually observed; almost every third postgraduate and doctoral student presents the results of their thesis for defending that is higher than in other fields of science.

Aim. To perform sanitary assessment of physical and chemical factors of the working environment of passenger car attendants in Mongolia.

Methods. The study for evaluation of working conditions was performed at attendants’ workplace in 36 passenger car manufactured in 1982-1999 in Russia and Germany and used for passenger transportation by Mongolian railway. Sanitary studies of physical and chemical factors of the working environment of passenger car attendants were conducted. Total of 1430 studies were performed.

Results. The results of sanitary evaluation of working conditions of Mongolian passenger car attendants indicate that air temperature, relative humidity, air flow, illumination, noise and vibration levels, dust content, carbon monoxide concentration, and diesel fuel products in some cases do not meet the sanitary requirements. Prolonged exposure to the combination of these factors can lead to organic disorders.

Conclusion. The working environment of Mongolian passenger car attendants is characterized by complex influence of unfavorable factors such as rapid changes of temperature during the shift, high levels of whole body vibration, dust, and presence of harmful chemicals in the air of the working area. Exposure to adverse factors of the working environment and work activities of passenger car attendants of Mongolian railway may cause harm to their health.

Aim. Assessment of hemophilia prevalence in Azerbaijan.

Methods. Materials of the study were the data of the registry on hemophilia. Prevalence and its structure were calculated for the regions and towns of republican subordination: the number of hemophilia patients with all types were calculated per 100 000 people. We determined the following groups: 0-4, 5-13, 14-18, 19-44, 45 years and older. According to clinical forms of the pathology we differentiated hemophilia А, hemophilia В, Willebrand’s disease and other forms. According to severity the patients were divided into 3 groups: severe with factors VIII and IX activity less than 1%, moderate - 2-5%, and mild - 5% and higher.

Results. Hemophilia prevalence in Azerbaijan Republic is 17.2±0.44 per 100 000 people. Baku is leading, where it is 33.1±1.22 hemophilia cases per 100 000 people. Relatively high prevalence rate was recorded in Sumgait city (22.8±2.61 per 100 000 people). Among hemophilia patients a male predominance is observed (1323 people, 87.2% of all patients). In all age groups hemophilia A is predominant and ratios of hemophilia B, Willebrand’s disease and other forms are significantly lower. Mild form of hemophilia was registered most often. Proportion of patients with severe hemophilia was lowest in the group with Willebrand’s disease (13%) and highest in the group with other hemophilia types (46.6%).

Conclusion. Hemophilia prevalence in Azerbaijan is high (17.2±0.44 per 100 000 people) and regional and age distribution differences are clearly pronounced; in nosological structure hemophilia A and other forms are predominant, nevertheless every fifth patients has severe form of the pathology.

Aim. To develop the algorithm of identification the signs of threatened preterm labour based on statistical and clinical comparison of modern available diagnostic tests: ultrasound cervicometry and express test-systems for measuring placental α1-microglobulin in cervical secretion.

Methods. The analysis of case histories of patients with a diagnosis of «threatened preterm labor» was performed.

Results. Total of 12 patients had premature labour accounting for 14.12%. In 8 of them placental α1-microglobulin in cervical secretion was positive and only in 5 patients cervical length was ≤20 mm according to ultrasound cervicometry. 4 patients with premature birth (ranging from 48 hours to 7 days) had false-negative test results. 7 (8.2%) patients had a false-positive result of placental α1-microglobulin test, and these patients subsequently had term birth. The sensitivity of the test for placental α1-microglobulin as a marker of premature birth was 66.67%, specificity 95.9%, specificity of ultrasound cervicometry - 47.9%, and sensitivity - 41.7%. Use of the combination of both tests can significantly reduce hyperdiagnosis of threatened preterm labour.

Conclusion. Females with short cervix according to ultrasound cervicometry should reasonably be tested for placental α1-microglobulin in cervical discharge; positive result of this test will be found in those whose probability to give preterm labour during the next 14 days reaches 72.72%, and high prognostic value of a negative test result allows observing the patients in outpatient setting.

Aim. To improve immunologic diagnosis of relapsing and residual echinococcosis we used the novel chemiluminescent method based on registration of changes of biologic fluids emmision in normal and pathologic conditions.

Methods. We observed 136 patients with relapsing echinococcosis, 109 patients with primary echinococcosis and 91 patients with residual cavities after echinococcectomy. As a control we included 186 patients with other diseases such as hepatitis, liver cirrhosis, liver and lung cancer, cholecystitis and others having some clinical similarity with echinococcosis and requiring differential diagnosis, and also 30 donors were included. Besides, 111 people previously operated for echinococcosis (6 month to 10 years prior) were examined.

Results. In comparison of immunochemiluminescence with well-known serologic test this method demonstrated some benefits: short time to receiving the results, small amount of the blood necessary for the analysis (0.02 ml), high specificity and sensitivity. As the time period after the surgery increases, intensity of luminescence in immunochemiluminescence gradually decreases in case of no relapse and increases in relapse.

Conclusion. Immunochemiluminescence of the whole blood is a valuable diagnostic method; this method should be included to diagnostic workup for patients with suspected echinococcosis; immunochemiluminescence provides the opportunity to define pathology and radicality of performed surgery and to reveal the disease relapse.